There’s an election looming in the UK, which is causing problems for the political parties. Everyone knows that we need major public spending cuts, but no politician is going to risk votes by committing to anything too great. So everyone is carefully skirting the issue, particularly where the NHS is concerned. The British public have a love-hate relationship with the NHS. They love to deride its inefficiencies and problems, but as soon as anyone attempts to take an axe to it, it transmutes into the most valuable aspect of being British.

Of course, those of us involved with healthcare know that this is more than just an election issue. The changing demographics mean that the NHS, and every other health system in the world is heading for financial meltdown. Rather than acknowledge it, our politicians (even those who have been pushing through the U.S. Health reform bill) are doing little more than being fitted for their lemming suits and asking for directions to the edge of the cliff. We cannot afford healthcare in its present form and we’re running out of time to address that inconvenient truth.

One straw that is invariable grasped and brandished is the potential of mHealth (or eHealth, telecare or eCare) to sweep away the costs. So in the spirit of helping our flailing politicians, I thought it might be an opportune time to review how it’s doing.

The first important thing to realise about mHealth is that it doesn’t need to be complex. Much of what can be achieved is through better management of resources and improved prevention. Back in 2005, the Sunday Telegraph reported that missed appointments cost the NHS £575 million every year. That’s enough to pay for 27,000 nurses or another 8,000 doctors. Don’t forget those numbers – we’ll come back to them later.

The obvious solution is to send reminders to patient’s phones. Back in 2005, a large percentage of patients didn’t have mobile phones. In the intervening five years that’s changed and companies like iPlato have been successfully rolling out a wide range of these text based services.

A further report was commissioned by mobile phone operator Vodafone, with the research carried out by Tanaka Business School, which was published the following year. It identified additional savings that could be made by using SMS support services for TB and diabetes sufferers. The report, titled “The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare” was available at www.vodafone.com/healthcare, until last year, when Vodafone announced its new mHealth initiative, at which point the healthcare section of its site mysteriously disappeared. You can still find it elsewhere on the net, and it’s worth a read.

At the same time, Orange Healthcare announced plans to launch an SMS reminder service in the UK. Their SMS gateway would also allow surgeries, hospitals and clinics to send out appointment reminders as well as to follow up appointments remotely. So with the pair of them supporting it, that ought to mean we’re saving our first half billion pounds.

Of course, mobile telephony is such a pervasive part of our everyday life that it worms its way into many other areas of the NHS. Keeping with the worm analogy, one of the more bizarre savings being proposed is the use of maggots to treat wounds. Believe it or not, 35 of our MPs, back in the heady days of fraudulent expenses, proposed that the NHS could save tens of millions of pounds by using maggots to eat the dead flesh on wounds, helping to prevent the spread of MRSA. I’m not sure whether maggot therapy can be counted as mHealth, but we’ll add it to the savings bucket.

Many commentators believe that the management and bureaucracy of the NHS needs to be reformed. And who better to do it than patients and doctors? According to Lloyds Pharmacies, a new generation of internet savvy and iPhone toting mothers are dispensing with doctors altogether, diagnosing their little darlings themselves and dosing them up at the local pharmacy. In the course of which they’re saving the NHS £825 million a year in prescription costs.

NESTA – the National Endowment for Science, Technology and the Arts, goes further and thinks that the mums and doctors ought to get together to redesign healthcare. Their rather aggressive report on “Patient Designed Services” reckons that this could lead to savings of £15 – £20 billion over the next few years.

Whilst the doctors are busy at their coffee mornings comparing iPhone apps with the mums, there’s a lot to be said for taking care of the remaining NHS staff who will inevitably end up doing all the work. Last year, an independent report by Steve Boorman outlined how NHS organisations could tackle staff health and wellbeing and save up to 3.4 million working days currently lost to sickness – equivalent to 14,900 extra staff or £555 million per year. Once again, a lot of what is suggested can be accomplished by using mobile phones, text alerts and a new generation of simple, connected health and fitness devices.

Of course, they could start off by walking to work. Not slow to jump on a bandwagon, the Ordnance Survey revealed that it had calculated the benefit of walking. By promoting walking, they believe that people could tackle their weight issues, reducing the incidence of early onset diabetes and saving the NHS half a billion pounds a year. Which is timely, as companies like fitbit and fitlinxx are just starting to sell internet connected pedometers – some of the first consumer mHealth products.

Others prefer to look to the automotive industry. After Gerry Robinson sorted out the NHS, BBC radio suggested that we could learn a lot from Toyota. Back in 2008, they enthused about Toyota’s production principles, claiming they could be applied to healthcare. Compared with Western systems, Toyota’s approach is tortoise versus hare: rather than seeking efficiency by speeding up individual activities, it focuses on improving the flow throughout the whole system, concentrating rigorously on customer demand. The result: a race-winning combination of higher quality and lower cost. Of course, that came before the recent Toyota recalls, so some might decide it’s safer to avoid the stuck accelerator of medical management and stay at home instead.

The good news is that you can still save the NHS money by staying at home. A recent report, ‘Hospital care at home’ by Healthcare at Home Ltd and Dr Foster (not from Gloucester), has shown that the free provision of home-based hospital care could save the NHS £1.2bn. Most of these services rely on remote sensors – either in the form of assisted living sensors, or more critical connected personal monitors. So mHealth triumphs again.

Of course, this may be too late. After all, in January 2007, a report from the British Medical Association said that unless the NHS were to undergoes a major overhaul, the Government will be forced to either cut the services it provides or to introduce a partially private system. Their prognosis was pretty terminal: that the NHS had only a year in which to be saved and that urgent action was vital. Incidentally, this is the same BMA who last week halted the Government roll-out of Summary Care Records (SCRs) that could be accessed by patients. Not to save money to save the NHS, but because it was happening at “break-neck speed”.

Summing up, I’ve done my sums based on all the saving that I’ve come across. And I reckon that if we can use mHealth to achieve all of those savings that have been promised above, it accounts for about £13.5 billion pounds a year. Which is more than the NHS spends on drugs.

Of course, you have to question how real the saving actually are? Back at the beginning we looked at the £575 million every year that could be saved from getting patients to turn up for appointments. That’s the equivalent of 27,000 nurses or 8,000 doctors. It’s a good solid application that is already out there and working, unlike some of the other more fanciful ones. But if you keep on employing those 27,000 nurses or 8,000 doctors you don’t realise the savings. You may have made the system more efficient, but with staff costs accounting for around 70% of the NHS budget, the only real savings will come from reducing staff numbers. mHealth may provide the route to achieve efficiencies that allow this, but by itself mHealth will add cost (because it involves additional new services or hardware). That’s a lesson that politicians and planners need to understand.

That’s my brief manifesto for mHealth and saving the NHS. Sadly, it’s probably as detailed as anything I’ll hear from this election campaign. I’m convinced that mHealth is where we need to go, but as soon as it starts delivering its promise, it will require some unpleasant decisions to be made regarding the number and type of medical staff that are needed. If the BMA thinks SCRs are a problem, they’ve not even noticed the tip of the iceberg.

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7 comments ↓

Whilst SMS Clinic/Patient Communication is a no brainer, I’m not so sure there is 575million to be made from no shows as this statistic is made on a flawed assumption that “Doctors/Nurses do nothing when patients don’t show”.

From my care experience I would say this is wildly inaccurate. Indeed sometimes these open slots can prove to be the most valuable in a carers day because they allow:

> For breaks
> For patients who just turn up (often with urgent issues) to get seen
> For more time to be given to particular patients who the Doctor/Nurse feels needs it

Although we are no doubt going to have to wait a few years until the statistics show this but I get the feeling that a particular problem facing the NHS (because GP visits are free to attend) is that some patients who wouldn’t turn up for a consult (eg. because they’re now feeling better etc.) agree to do so anyway because of the SMS reminder. How does this save money?

PS. It really annoys me when companies (like Vodafone) delete their previous online communications because it doesn’t suit their current position (eg. that mHealth is an innovative new thing!). I recall being at Imperial for the launch of this particular report (by Alan Harper) and it was and still is a very informative document.

An wide ranging piece but I would like to offer some corrections and primary research:
– “Back in 2005, a large percentage of patients didn’t have mobile phones”. Numerous research shops will quote you a penetration rate of mobiles per capita in excess of 100% for the UK in 2005. WEF data suggests 125% – and approx 50 bn SMS sent in that year.
– Savings of £575M p.a. I agree its a specious number because it depends on how the savings are measured. Within English acute trusts with a ‘Payment by Results’ (PbR) scheme the savings could actually be much greater. David Doherty correctly asserts that unscheduled time generated by DNAs is used productively, however, it is not seen as productive in the context of PbR, therefore is money wasted.
– This notional £15-20bn the NHS is expected to ‘save’ between 2011-14 won’t be generated from staff cuts. In a PbR setting cutting clinical staff (call them ‘fee earners’) reduces trust earning ability so is largely self-defeating. Further, tariff agreements don’t allow trusts to raise their ‘prices’ to generate more revenue. That leaves capacity. Primary Care provider arms and secondary trusts run at about 85% capacity. Get that 85% to (say) 90% and the 5% increment generates revenue and savings that put a noticeable dent in that £15-20bn. Get the figure to 95% and we are on our way. This is a real sweet spot for m-health, but not based on current thinking. To explain:
– From work we have done in this area, many NHS trusts believe that there are more landlines than mobile phones in the UK. So, the average acute trust has a patient mobile phone capture rate between 5-15%. Elderly patients don’t use mobiles (or not usually SMS) which doesnt really matter because the majority of DNAs are generated by younger patient cohorts who DO use SMS – a lot. So, m-health, when targeted at the right cohort will generate significantly quantifiable results, but only if the trust has already captured their mobile number. Given that there are 31 million landlines in the UK and 78 million mobiles it makes sense for the NHS (as a mandate) to actively compel patients 16-45 to provide their mobile as their default contact number. Draconian? Probably, but that will generate more value more quickly than a lot of these wishy-washy initiatives being generated the Operators to ensure they are the SMS carrier.
Pharmacies: iPhone toting mothers diagnosing little Johnny is great – so long as they are diagnosing correctly. Maybe doctors don’t need to go to med school for 7 years, but I know where I would rather get specialist opinion about my health from.
So, the issue isn’t the headline stuff from 5 years ago – the problems are more subtle and the solutions more complex than any headline can describe anyway. Fortunately between SMS and the emerging availability of MMS, there are real m-Health solutions that WILL improve patient well-being whilst ensuring budgets can balance, but these solutions will NOT be the simple application of clever technologies, but an acceptance within healthcare management that they must adapt long ingrained practices to help their m-Health provider to help themselves.

[…] of analyst predictions estimated sales of around $4 billion per year by 2014, and my own more fanciful review of potential savings ran into tens of billions of dollars. Network Operators are setting up mHealth divisions faster […]

[…] recent roundup of analyst predictions estimated sales of around $4 billion per year by 2014, and my own more fanciful review of potential savings ran into tens of billions of dollars. Network operators are setting up mHealth divisions faster […]

[…] widely used for appointment reminders. All sorts of claims have been made for how much this is saving the NHS, and I took a rather light-heated look at this is a previous blog. Not as much is being written […]

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About Creative Connectivity

Creative Connectivity is Nick Hunn's blog on aspects and applications of wireless connectivity. Having worked with wireless for over twenty years I've seen the best and worst of it and despair at how little of its potential is exploited.

I hope that's about to change, as the demands of healthcare, energy and transport apply pressure to use wireless more intelligently for consumer health devices, smart metering and telematics. These are my views on the subject - please let me know yours.

Essentials of Short Range Wireless

A helping hand for wireless designers

Adding wireless connectivity to a product is a major challenge for any designer. There are so many new concepts, and a plethora of suppliers claiming they’ve solved them for you. I’ve tried to distil 20 years of experience into this book to help you get over the pitfalls, ask the right questions and make sure you understand the answers.